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Original Research: Sleep Disorders |

The Epworth Sleepiness ScaleSelf- vs Physician-administered Sleepiness Scale: Conventional Self vs Physician Administration

Mario Francesco Damiani, MD; Vitaliano Nicola Quaranta, MD; Vito Antonio Falcone, MD; Felice Gadaleta, MD; Michele Maiellari, MD; Teresa Ranieri, MD; Francesco Fanfulla, MD; Pierluigi Carratù, MD, PhD; Onofrio Resta, MD, FCCP
Author and Funding Information

From the Institute of Respiratory Disease (Drs Damiani, Quaranta, Falcone, Gadaleta, Maiellari, Ranieri, Carratù, and Resta), University of Bari, Bari, Italy; Hospital “Salvatore Maugeri” (Dr Fanfulla), Pavia, Italy.

Correspondence to: Mario Francesco Damiani, MD, Piazza Giulio Cesare 11, Bari, Italy; e-mail: mariodmn84@hotmail.com


Funding/Support: The authors report to CHEST that no funding or other support was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;143(6):1569-1575. doi:10.1378/chest.12-2174
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Background:  The Epworth Sleepiness Scale (ESS) is a simple, self-administered questionnaire that provides a measurement of the subject’s level of daytime sleepiness, and is widely used for patients with obstructive sleep apnea (OSA). Some works undermined its accuracy. The aim of this study was to compare self-administered ESS scores to physician-administered scores in a sample of patients with suspicion of OSA.

Methods:  Patients were randomly divided into two groups: group 1, or the self-administered group (n = 113); and group 2, or the physician-administered group (n = 112). Patients in group 1 were asked to complete the ESS in the traditional way; in group 2, the ESS was administered by a sleep-medicine physician. Subjects in both groups underwent diagnostic in-laboratory portable monitoring (PM) within 1 week’s time.

Results:  The percentage of questionnaires properly completed was significantly different between groups: 77% (87 of 113) in the group 1 vs 100% (112 of 112) in the group 2 (P = .00). Scores obtained when a physician administered the questionnaire (ESSp) were higher than those when the ESS was self administered (ESSs) (ESSp:12.09 ± 4.1 vs ESSs:10.37 ± 5.49; P = .01). The ESSp was more highly correlated with apnea-hypopnea index and oxygen desaturation index than the ESSs.

Conclusions:  Our results lead us to consider the physician-administered ESS to be more accurate than the traditional ESS; thus, our suggestion is to validate this new method of administration.

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